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Descemet Membrane Endothelial Keratoplasty After Failed Penetrating Keratoplasty

Pierné, Kévin MD*; Panthier, Christophe MD, MSc*; Courtin, Romain MD*; Mazharian, Adrien MD*; Souedan, Vael MD*; Gatinel, Damien MD, PhD*,†; Saad, Alain MD*,†,‡

doi: 10.1097/ICO.0000000000001834
Clinical Science

Purpose: To demonstrate the feasibility of Descemet membrane endothelial keratoplasty (DMEK) performed after previous penetrating keratoplasty (PK) failure and to describe primary outcomes.

Methods: Twenty-eight eyes of 28 patients who underwent DMEK after primary PK failure between January 2013 and November 2017 were included in this single-center retrospective study. Best spectacle-corrected visual acuity, endothelial cell density, and the recipient's central corneal thickness were recorded preoperatively and at 1, 3, and 6 months after surgery.

Results: The main indications for primary PK were keratoconus (32%), Fuchs dystrophy (18%), and pseudophakic bullous keratopathy (14%). After a 6-month follow-up, best spectacle-corrected visual acuity was significantly improved in 26 patients (93%) with a mean gain of +0.59 ± 0.47 LogMAR (P < 0.0004). Mean pachymetry reduction was 110 ± 108 μm (P < 0.00003) at 6 months. Mean endothelial cell density was 2016 ± 288 cells/mm2 (P < 0.006), (24% decrease compared with preoperative values). Graft detachment (>1/3) was observed in 14 cases (50%) and rebubbling was needed (100% effective) during the first 2 weeks after surgery. Elevated intraocular pressure was reported in 5 cases. No early graft rejections were reported.

Conclusions: In case of previous PK failure, DMEK is an alternative treatment to re-PK. A longer follow-up to ensure the long-term viability of the graft is needed.

*Department of Ophthalmology, Rothschild Foundation, Paris, France;

Cataract, Cornea and Refractive Surgery Unit, CEROC (Center of Expertise and Research in Optics for Clinicians), Paris, France; and

Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.

Correspondence: Alain Saad, MD, Department of Ophthalmology, American University of Beirut, Medical Center, PO Box 11-0236, Beirut, Lebanon 11-0236 (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received August 06, 2018

Accepted November 05, 2018

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